Plan Materials and Forms

Information about plan benefits, services, and drug costs can be found in your plan materials.

Look at your Wellcare By Allwell from Magnolia Health member ID card for your plan number and type to view materials for your plan.

View a sample of an Wellcare By Allwell Member ID Card to see where this information is located.

You can also look for plan materials based on the plan name and the county you live in.

If you don’t have a Wellcare By Allwell from Magnolia Health ID card or have questions about plan materials, give us a call. We’re here to help.

This booklet gives you a summary of costs and coverage in your plan.

Please select the document for your plan and county:For HMO Members:

Plan Name	CMS#	County	Summary of Benefits
Wellcare No Premium Medicare (HMO)	H9811-001	George, Hancock, Harrison, Hinds, Jackson, Madison, Rankin and Stone counties	Summary of Benefits - H9811-001 - English (PDF) Summary of Benefits - H9811-001 - Spanish (PDF)
Wellcare Giveback Boost (HMO)	H9811-008	George, Hancock, Harrison, Jackson	Summary of Benefits - H9811-008 - English (PDF) Summary of Benefits - H9811-008 - Spanish (PDF)
Wellcare Assist Complement (HMO)	H9811-009	George, Hancock, Harrison, Jackson	Summary of Benefits - H9811-009 - English (PDF) Summary of Benefits - H9811-009 - Spanish (PDF)

For HMO D-SNP Members:

Plan Name	CMS#	County	Summary of Benefits
Wellcare Dual Access Medicare (HMO D-SNP)	H9811-006	George, Hancock, Harrison, Hinds, Jackson, Madison, Rankin and Stone	Summary of Benefits - H9811-006 - English (PDF) Summary of Benefits - H9811-006 - Spanish (PDF)

This booklet gives you a complete list of services, limitations and exclusions for your plan coverage.

Please select the document for your plan and county:

For HMO Members:

Plan Name	CMS#	County	Evidence of Coverage
Wellcare No Premium Medicare (HMO)	H9811-001	Desoto, George, Hancock, Harrison, Hinds, Jackson, Lafayette, Madison, Panola, Rankin, Stone, Tate	Evidence of Coverage-H9811-001 - English (PDF) Evidence of Coverage-H9811-001 - Spanish (PDF)
Wellcare Giveback Boost (HMO)	H9811-008	George, Hancock, Harrison, Jackson	Evidence of Coverage-H9811-008 - English (PDF) Evidence of Coverage-H9811-008 - Spanish (PDF)
Wellcare Assist Complement (HMO)	H9811-009	George, Hancock, Harrison, Jackson	Evidence of Coverage-H9811-009 - English (PDF) Evidence of Coverage-H9811-009 - Spanish (PDF)

Plan Name

CMS#

County

Evidence of Coverage

Wellcare No Premium Medicare (HMO)

H9811-001

Desoto, George, Hancock, Harrison, Hinds, Jackson, Lafayette, Madison, Panola, Rankin, Stone, Tate

Evidence of Coverage-H9811-001 - English (PDF)

Evidence of Coverage-H9811-001 - Spanish (PDF)

Wellcare Giveback Boost (HMO)

H9811-008

George, Hancock, Harrison, Jackson

Evidence of Coverage-H9811-008 - English (PDF)

Evidence of Coverage-H9811-008 - Spanish (PDF)

Wellcare Assist Complement (HMO)

H9811-009

George, Hancock, Harrison, Jackson

Evidence of Coverage-H9811-009 - English (PDF)

Evidence of Coverage-H9811-009 - Spanish (PDF)

For HMO D-SNP Members:

Plan Name	CMS#	County	Evidence of Coverage
Wellcare Dual Access Medicare (HMO D-SNP)	H9811-006	George, Hancock, Harrison, Hinds, Jackson, Madison, Rankin and Stone	Evidence of Coverage - H9811-006- English (PDF) Evidence of Coverage - H9811-006- Spanish (PDF)

Plan Name

CMS#

County

Evidence of Coverage

Wellcare Dual Access Medicare (HMO D-SNP)

H9811-006

George, Hancock, Harrison, Hinds, Jackson, Madison, Rankin and Stone

Evidence of Coverage - H9811-006- English (PDF)

Evidence of Coverage - H9811-006- Spanish (PDF)

This booklet will tell you about changes to your plan’s costs and benefits for the coming year.

Please select the document for your plan and county:

For HMO Members:

Plan Name	CMS#	County	Annual Notice Of Changes
Wellcare No Premium Medicare (HMO)	H9811-001	George, Harrison, Hinds, Jackson, Madison, Rankin and Stone counties	Annual Notice of Changes -H9811-001- English (PDF)
Allwell Medicare (HMO) to Wellcare No Premium Medicare (HMO)	H9811-005 - H9811-001	DeSoto, Lafayette, Panola, and Tate counties	Annual Notice of Changes - H9811-005 - H9811-001 - English (PDF) Annual Notice of Changes - H9811-005 - H9811-001 - Spanish (PDF)
Wellcare Giveback Boost (HMO)	H9811-008	George, Hancock, Harrison, Jackson	Annual Notice of Changes -H9811-008 - English (PDF)
Wellcare Assist Complement (HMO)	H9811-009	George, Hancock, Harrison, Jackson	Annual Notice of Changes - H9811-009 - English (PDF)

For HMO-D-SNP Members:

Plan Name	CMS#	County	Annual Notice Of Changes
Wellcare Dual Access Medicare (HMO D-SNP)	H9811-006	George, Hancock, Harrison, Hinds, Jackson, Madison, Rankin and Stone	Annual Notice of Changes -H9811-006 - English (PDF)

Plan Benefit Materials |

Plan Materials and Forms

For HMO D-SNP Members:

For HMO Members:

For HMO D-SNP Members:

Plan Benefit Materials

For HMO D-SNP Members:

For HMO Members:

For HMO D-SNP Members:

Plan Benefit Materials |

Plan Materials and Forms

Summary of Benefits (SB)

For HMO D-SNP Members:

Evidence Of Coverage (EOC)

For HMO Members:

For HMO D-SNP Members:

Annual Notice of Changes (ANOC)

Over-The-Counter Benefits

Plan Benefit Materials

Summary of Benefits (SB)

For HMO D-SNP Members:

Evidence Of Coverage (EOC)

For HMO Members:

For HMO D-SNP Members:

Annual Notice of Changes (ANOC)

Over-the-Counter Catalog

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